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Bruno, Tony W; Alter, Scott M.
Journal of the American College of Emergency Physicians Open; Hoboken Vol. 2, Iss. 6, (Dec 2021).
DOI:10.1002/emp2.12607
A 72-year-old female presented to the emergency department with 5 days of left lower leg pain, swelling, and redness in her calf radiating to the heel. She had a similar occurrence 2 years ago and was diagnosed with superficial thrombophlebitis. The patient has no other past medical history. Physical examination of the left lower extremity revealed swelling and tenderness over the posterior aspect of the calf with mild overlying erythema. Distal pulses, motor, and sensation were intact. Bedside ultrasound was performed, revealing an enlargement of the popliteal vein measuring 3 cm in diameter, with a central normal flow channel and a peripheral dilatation containing swirling, turbulent flow without thrombus (Figure 1A,B and Video 1).
FIGURE: Ultrasound of the left leg demonstrating an enlargement of the popliteal vein containing swirling, turbulent flow
FIGURE: Ultrasound of the left leg demonstrating an enlargement of the popliteal vein containing swirling, turbulent flow
DIAGNOSIS
Popliteal vein aneurysm. Ultrasound was consistent with a popliteal vein aneurysm, without associated thrombus and no connection to the popliteal artery. Vascular surgery was consulted and recommended resection of the aneurysm. However, the patient declined to have any intervention performed. The patient was treated with oral anticoagulation and discharged home with instructions to follow up with vascular surgery if she reconsiders aneurysm resection.
Popliteal vein aneurysms are a rare finding associated with high risk of venous thromboembolism.1 Therefore, to prevent these complications, operative management is the preferred treatment.1 Alternatively, patients may be placed on anticoagulation therapy, though there is no standardized course of treatment.1 The best management of asymptomatic popliteal venous aneurysms, particularly small ones, is less clear; generally these aneurysms should also be repaired surgically because of their potential for severe complications.2
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